HomeMy WebLinkAbout002-940-03-4106-LUP-1988-239 Application for Land Use Permit
County of Sawyer y
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The undersigned hereby makes application for a Land Use Permit and agrees �
that all work shall be done in accordance with the requirements of the Sawyer � '
County Zoning Ordinance and the laws and regulations of the State of Wisconsin.
PRINT - USE ONLY BLACK INK/PENCIL
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Owner Builder
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mailing address mailing a dress �
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city, state, zip city, state, zip
Building Land Use Zone District �-1
(�Q New ( ) Filling � p
( vy°'�Addition ( ) Dredging Lot size ,�„�� X /2 �''7 � � �
( ) Alteration ( ) Grading �, n
( ) Moving on ( ) Acres /Q, �f
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New Construction �° ' �, , '� ���1� ��J1� ��
S�'oR�G.�; 1r���,. .},�_ �
Size � g ft wide (L ft wide
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�� ft long �_ ft long
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Floor area �f �Q sq ft �(�g sq ft
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Total hgt to peak �� to peak = ��'� 7r {
Stories _� �
No. of bedrooms ' rear lot line or waterline
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(year round) or (seasonal) � '
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Type of bldg or addition i � � �
( ) Dwelling � i �, r+
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( ) Garage (1) (2) car � i � o
�j Storage building //�1/j����h�r i /-� i C rt
� ) Boathouse � �� c� a i ��
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( ) Livingroom i �Z�7 � i �
O Bedroom i� 12� -_.� g�12 t�� ; i
( ) Kitchen-dining i �� � i
( ) Porch - enclosed/roofed � k'3 '
i ",up � i
(�j' Deck - open � �
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( ) � v ��k' Iq 5 -----� � �
�:�-'. 24
c ) i ��� �v 30 40 �$ ��__ � � �"
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Type of construction i ��`� 3' ' ' �.t � �
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(�Q Frame O Block i 1 _` Z�, i
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( ) Log ( ) Concrete i: ' �� �t..�,,; ,���.� �
( ) Pole ( ) Steel i ` � 4 k x� �y i {�-°'�
O Metal O i � a,. 3 N � �� �� i �
Construction cost $ �� ' �� i �'► f 2 � � i � �
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Vol �_ Pg � of deed i � � '�g� �"�5`�i j
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CSM Vol ---�"-" --- i � ; � i �
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Cer. Soil Test �� - �...:..� � � � �
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Sanitary Permit i%� - �.,,�` ►=►���IN� '�i1fi� "
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Issued � (D `S��p ��� Denied ��L --
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Ti/�l'��l J A 1 � Y� ��L -1
owner Zoning Administ ator �
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"� � � � � State and County State Permit # 13953 `
� � �r � Permit Application County Permit # 9 - 232
r ` for Private Domestic Sewage Systems County Saw_,yer __
DENOTES STATE APPROVAL REQUIRED CST 9 - 240
?ate Approval Received from State if Required 5iate Plan I .D. #
A. OWNER OF PROPERTY Mailiny Address:
�' ✓'c �'. '1�-� �r�i p 0 , C3 vx 7o yw ' , sug � .
3. LOCATION: Yn •,� Ye , Section , T , R (�,) W Lot# City
Subdivision Name, nearest road, lake or laridmark Blk# Village
� �, Township �S L �} /�
J 'C�C�/ .
;. TYPE CF OCCUP NC : Commercial 'Industrial "Other (specify� 'Variance
Single family �_ Duplex No. of Bedrooms � No. of Persons
�• SEPTIC TANK CAPACITY 7 S O Totat gallons No. of tanks
HOLDING TANK CAPACITY Total gailons No. of tanks
Prefabconcrete Poured-in-Place Steel_/�_ Fiherglass Other �specify)
New Instaliation �; Replacement _ _
Lift Pump Tank or Siphon Chamber Total gailons Prefab concrete Poured-in-Place Other (Specify)
----- ---- - ---- _ __ - - _ - -_ __ __
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_, EFFLU NT DISPOSAL SYSTEM : Percolation Rate � Total Absorb Area � sq. ft.
New Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed:.—�_Length ��� Width ��- Depth�—Tile depth �top)___.c��No. of Lines �
Seepage Pit: tnside ��i�ter �e��pth No. of Seepage Pits
Percent slope of Ianci�T Cf �.�.�e* -r4.� Distance from critical siope��'�-� /�'P"�-
'ATER SUPPLY: Private � Joint ❑ Comm�mity ❑ Municipal ❑
�.vners name as listed on EN 115 if other than present owner: �r
� the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
,1,�isconsin Administrative Code, and that I fiave sized the effluent disposal system from the EH-115 prepared
�y the C�e+rtified Soil Tester, �— ) , � �
!AME C_ �� �����C J¢L � C.S.T. # �F and other information
�btained from S /�' {owner/builder�. p
'lumber 's Signature � Mp��Jp�� �� / � Phone #7� ,5� 3 � � o�,��/�
'lumber's Address
i PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimensior location of all we►Is on the property or neighbors
property. If well has not been drilled please indicate.
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- Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY
� of Application IO - 24 - 79 _Fees Paid: State 15 . 00 County 1. 5 . 00 _ Date 24 October 1979
mit Issued/�Ce'Fel��pi (date) 10 - 24 - 79 Issuing Agent Name Elaine NehrliTla
�ection Yes�ju�No State Valid# Date Rec'd
county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78
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Department of Zonin� and Sanitation
Sawyer County �
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Inspection Report y
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Owner Lura M. and Eric G. Velin '�
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Addrese P.O. Box 704 Hayward, WI 54843 �
Tdame of busi.ness C
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Builder �'
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Address
Plumber Clarence Metcalf
Addre�s Route 6 Box 157 tiayward, WI 54843
Inspection
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(� Private ( ) Public Property 3anitary-instal �* �
�' Dwelling 3etback - lake
Violation Mobi_le FUn Setback • road °
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Gara�e Setback-lot line
( � 3anitar,y ( ) Zoning privy
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Discussed with owner yes no �
Discussed with Builder yes no
Di.scussed with plumber yes no �
Discussed with yes no
vute .�J���L�' 9 �.
ignature of Officer `
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